ACO Success Factors: Identifying Key Strategies

Accountable care organizations (ACOs) have been the most popular vehicle for value-based payment model adoption to date, with over 923 ACOs covering approximately 32.4 million lives across the country. Recognizing the importance of successful ACO implementation, the Health Care Transformation Task Force (HCTTF) released a comprehensive analysis of high-performing ACOs and ACO success factors.

Healthcare Consumer Engagement Gap With Payers: They Want…?

Change Healthcare (CH) announced payer insights revealed in The Engagement Gap: Healthcare Consumer Engagement in 2017, a new national study of 89 payers, 251 providers, and 771 consumers. CH asked payers about the factors influencing their consumer-centric initiatives, and how these strategies are altering their organizations. Health plans surveyed were generally aligned in pointing to value-based care as the primary factor driving their focus on consumer-centricity, with 74% reporting it as the leading factor.

Health Insurance Plan Ratings for 2017: NCQA Releases Top 10 List

NCQA’s Health Insurance Plan Ratings 2017–2018 compare the quality and services of more than 1,000 health plans in the United States and provide consumers with a practical and meaningful guide to understanding their health care options and choosing the best health plans for themselves and their families. National Committee for Quality Assurance (NCQA) is releasing its 2017 Health Insurance Plan Ratings. These ratings provide consumers with a more accurate picture of how health insurance plans perform in the key quality areas of consumer satisfaction, prevention and treatment.

Stable Health Insurance Markets: Maintenance and Alternative Methods

The Association for Community Affiliated Plans (ACAP) issued a report which examines possible alternatives to the individual mandate for health insurance coverage brought about by the Affordable Care Act and evaluates their cost and efficacy. It suggests that if the individual mandate were to be repealed, a mixture of alternative mechanisms would be required to serve a similar role in maintaining a healthy risk pool in the individual stable health insurance market.

Autism Care Costs: Healthcare’s Perfect Storm

Autism care costs balance in the middle of many competing issues and agendas leaving payers, providers, and consumers trying to sort out the facts from fictions. The size of the funding pie “…over the next 10 years [is] about a half a million youth with autism spectrum disorder (ASD) will enter adulthood. The majority of the costs in the U.S. health care systems for ASD are directed at the adult population: $175 to $196 billion for adults compared to $61 to $66 billion for children.” writes Monica Oss, CEO, Open Minds.

EHR Documentation Stretching Reimbursement Cycles?

Payers and providers need efficient administrative services for profitability. With all the capital and human resources invested in electronic health records and data exchange security, why are documentation errors still one of the highest cause of adverse determinations? The number of claims slowed by lack of/incomplete/poor EHR documentation became crystal clear in recent reports.

5 Medical Cost Pressures Shaping 2018

The era of volatile swings and double-digit growth in employer medical costs appears to be ending. With medical cost trend hovering in the single digits for several years, the industry has been waiting for the inflection point when spending will take off. But that spike appears unlikely to happen. The New Health Economy is settling into a “new normal,” typically characterized by more attenuated fluctuations and a single-digit trend.For four years, medical cost trend has hung between 6 and 7 percent, seeming to settle into a “new normal.” PwC’s Health Research Institute (HRI) anticipates a 6.5 percent growth rate for calendar year 2018, half a percentage point higher than in 2017.

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